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Risk Assessments for Adolescent Depression and Suicide

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Between 10 to 15 percent of teenagers have some symptoms of teen depression at any one time. ... Teenagers with depression are likely to have a smaller social ... – PowerPoint PPT presentation

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Title: Risk Assessments for Adolescent Depression and Suicide


1
Risk Assessments for Adolescent Depression and
Suicide
  • ISANNE Conference
  • Inn at Mill Falls- Oct. 21, 2008
  • Will White LCSW, LADAC

2
Outline of talk
  • Intro
  • Underlying Assumptions
  • Overview of depression and adolescents.
  • Overview of suicide and adolescents.
  • Sharing of experiences.

3
  • This talk is not intended to be a substitute for
    a psychiatric/psychological evaluation of an
    adolescent who may be depressed or suicidal. A
    referral to appropriate mental health
    professional should be made whenever there are
    concerns about the mental health of an adolescent.

4
Underlying Assumptions
  • Current research shows what teachers, counselors,
    and mothers (and some fathers) knew. The
    adolescent brain is in the process of remarkable
    change. Behaviors are erratic and similar, at
    times, to schizophrenia or other types of mental
    illness (NIMH, 2008).

5
Underlying Assumptions
  • During adolescents is when the first signs of
    emerging mental illness occur. Wisdom is knowing
    who is just being an adolescent or is emerging
    as mentally ill. Current research is showing
    the sooner you treat emerging mental illness the
    less brain damage.

6
Depression
  • Three ways to view depression
  • Genetic
  • Situational
  • Combination of the two

7
Depression
  • Genetic- Good old family tree. One is born with
    the nose, ears, and disposition of some mixture
    of the past.
  • Best treated with medications.

8
Depression
  • Situation- What is happening or happened.
  • Break up.
  • New school.
  • Long periods of darkness (When is highest suicide
    rates?).
  • When you look at retirement account.
  • Other examples Trauma, Chronic drug abuse, Death
    of family members.
  • According to research people bounce back to their
    state of happiness after a period of time.
    Winning a lottery or losing a loved one
    (Lyubomirsky, 2007).

9
Depression
  • Combination of the genetics and situation.
  • Long periods of stress can impact ones mind. The
    majority of people will be resilient of
    situational depression. In some cases it will
    turns the key to unlock a long contained
    depression.
  • Long periods of stress (or alcohol and other drug
    abuse) can damage the brain and create a
    difficult depression to treat.

10
Depression numbers
  • About 20 percent of teens will experience teen
    depression before they reach adulthood. 
  • Between 10 to 15 percent of teenagers have some
    symptoms of teen depression at any one time. 
  • About 5 percent of teens are suffering from major
    depression at any one time 
  • As many as 8.3 percent of teens suffer from
    depression for at least a year at a time,
    compared to about 5.3 percent of the general
    population. 
  • Most teens with depression will suffer from more
    than one episode. 20 to 40 percent will have more
    than one episode within two years, and 70 percent
    will have more than one episode before adulthood.
    Episodes of teen depression generally last about
    8 months. 
  • A small percent of teens also suffer from
    seasonal depression, usually during the winter
    months in higher latitudes.
  • (Report from the Surgeon General, 1998)

11
Depression numbers
  • 30 percent of teens with depression also develop
    a substance abuse problem. 
  • Teenagers with depression are likely to have a
    smaller social circle and take advantage of fewer
    opportunities for education or careers. 
  • Depressed teens are more likely to have trouble
    at school and in jobs, and to struggle with
    relationships.   
  • Untreated depression is the number one cause of
    suicide, the third leading cause of death among
    teenagers.
  • (Report from the Surgeon General, 1998)

12
Adolescent Depression Paradox
  • Depressed Adolescents are difficult to identify
    and can be confused with other disorders
  • ALWAYS RULE OUT MEDCIAL ISSUES-
  • ADD
  • Substance Abuse (prescribed medication)
  • PTSD
  • Anxiety.
  • Dysthymia

13
Adolescent Depression Risk Factors
  • In childhood, boys and girls appear to be at
    equal risk for depressive disorders but during
    adolescence, girls are twice as likely as boys to
    develop depression. Children who develop major
    depression are more likely to have a genetic
    history of the disorder, often a family member
    who experienced depression at an early age, than
    patients with adolescent- or adult-onset
    depression.
  • (athealth.com 2008)

14
Adolescent Depression Risk Factors
  • Risk factors
  • Stress
  • Transitions
  • Alcohol and drug abuse
  • Long winters
  • Adoption
  • A loss of a parent or loved one
  • Parents divorce
  • Break-up of a romantic relationship
  • Learning disorders
  • Chronic illnesses
  • Abuse or neglectOther trauma, including natural
    disasters

15
Adolescent Depression Symptoms
  • Sadness or hopelessness
  • Irritability, anger, or hostility
  • Tearfulness or frequent crying
  • Withdrawal from friends and family
  • Loss of interest in activities
  • Changes in eating and sleeping habits (either
    way)
  • Restlessness and agitation
  • Feelings of worthlessness and guilt
  • Lack of enthusiasm and motivation
  • Fatigue or lack of energy
  • Difficulty concentrating
  • Thoughts of death or suicide

16
Adolescent Depression Useful tools for assessment
  • Extensive family and social history.
  • Extensive medication and medical history.
  • Conversations with current or previous
    psychotherapist.
  • Conversations with support system.
  • Becks depression inventory II.
  • Reynolds Adolescent Depression Scale- 2.
  • Mood and Feelings Questionnaire.
  • Experience.

17
Adolescent Depression Best Treatments for
Depression
  • Cognitive Behavioral psychotherapy tends to be
    effective with situational depression.
  • Medications tend to be effective with genetic
    depression.
  • Combination of the two is often the best way to
    initially treat.
  • Always assess for suicidality.

18
Adolescent Suicide
  • http//www.youtube.com/watch?vdTeytkxlDt8feature
    related

19
Nationwide Suicide Numbers
  • 32,000 people successfully complete suicide a
    year.
  • Someone attempts suicide every minute.
  • Someone successfully suicides every 16 minutes.
  • Numbers do not include car accidents or
    overdose without a note.
  • - (National Center for Health,2008)

20
Adolescent Suicide Numbers
  • Male adolescents die by suicide at a rate 4x
    higher than females.
  • Female adolescents attempt suicide at a rate 3X
    higher than males
  • Of all suicide completions 80 are male- 75 are
    white males.
  • Asian American females aged 14-24 have the
    highest suicide rate (not attempts) of all the
    females of ethnicity
  • Gay, lesbian, bisexual, transgender, questioning
    have a 4X greater risk of suicide attempts than
    heterosexuals.
  • - (CDC, 2008)

21
Adolescent Suicide Numbers relate to New
Hampshire
  • US average of suicides per 100,000 is 10.8.
  • New Hampshire average of suicides per 100,000 is
    13.3.
  • Suicide is the 2nd leading cause of death after
    accidents for 10-24 year olds in NH.
  • - (CDC, 2008)

22
Adolescent Suicide Numbers relate to New
Hampshire
  • Guns
  • Presence of a firearm in a home increases the
    likelihood of a suicide by 5 times
  • Rural settings
  • Long winters
  • Isolation.
  • - (Kellermann, et al, 1992)

23
Adolescent Suicide Risk Factors
  • Mental health problems, including depression,
    bipolar disorder, and anxiety disorder.
  • Alcohol and other substance use problems
  • Loss
  • Poor impulse control
  • Personality disorders
  • - (NAMI NH 2006)

24
Adolescent Suicide Risk Factors
  • History of trauma or abuse (physical, mental, or
    sexual).
  • Prior suicide attempt (significantly increases
    risk)
  • Fascination with death and violence
  • History of bullying or interpersonal conflict
  • Compulsive, extreme perfectionism.
  • - (NAMI NH 2006)

25
Adolescent Suicide Family Risk Factors
  • Family history of suicide.
  • Depressed and/or suicidal parents.
  • Alcoholic and/or drug-addicted parents.
  • Changes in the family structure (death, divorce,
    remarriage)
  • Financial difficulties.
  • - (NAMI NH 2006)

26
Adolescent Suicide Indicators of risk
  • Difficulties at school
  • Neglect of physical appearance
  • Dropping out of activities
  • Sudden improvement in mood- after being down or
    withdrawn.
  • Giving away favorite possessions.
  • Break up with a long time partner.
  • Coming out.
  • - (NAMI NH 2006)

27
Adolescent Suicide Need for immediate action
  • Threatening to hurt or kill oneself or talking
    about wanting to hurt or kill oneself.
  • Looking for or asking about ways to kill oneself
    by seeing access to firearms, pills, or other
    means.
  • Writing about death, dying, or suicide.
  • - (NAMI NH 2006)

28
Adolescent Suicide Need for immediate action
  • Rage or uncontrollable anger.
  • Acting reckless.
  • Withdrawing from friends, family, and society.
  • - (NAMI NH 2006)

29
Adolescent Suicide What to do
  • Meet with student to evaluate. Evaluation for
    risk is complicated and difficult.
  • There is no clear set of protocols and procedures
    that guarantee success.
  • A good assessment depends on good skills and
    judgment of the clinician.
  • No suicide contracts are not backed up by
    research! Although it may be a procedure there
    is little evidence of true effectiveness.
  • When in doubt refer out.
  • - (NAMI NH 2006)

30
Adolescent Suicide What to do
  • Contact parents.
  • Get parents o.k. to do evaluation.
  • If parents are not available and it is deemed as
    life-threatening emergency, you may perform
    evaluations without permission.
  • When evaluating make sure you are in a high
    visibility area.
  • Do not leave student unsupervised
  • Conduct the interview in a safe and secure area
  • Make sure no potentially dangerous objects are in
    office.
  • Communicate with others.
  • Do not agree to keep a secret.
  • Find out if they are under the influence
  • Ask directly about suicide.
  • - (NAMI NH 2006)

31
Adolescent Suicide What to dowhen a student is
voluntary.
  • Find out if the student is willing to be
    hospitalized. Encourage the student that if
    they are at danger to themselves than the safest
    place to be is a hospital setting.
  • If they are willing to be voluntarily admitted
    then work with the family, and their insurance
    company, to find psychiatric hospital.
  • Always have the student in sight. Even in the
    bathroom!
  • Call the crisis line on the insurance companies
    card to inform them of the situation and the need
    for a psychiatric hospital due to danger of self.
    Insurance companies have contracts with
    psychiatric hospitals that make it easier for
    admission.
  • Work with the family and student to provide
    safe transportation to a hospital setting. If
    school has to transport due to logistics have two
    staff go with student. Before letting student in
    a vehicle ask for commitment not to harm self.
    Put student in the back of the car with one
    staff. Control locks on the doors.
  • Transport student directly to emergency
    room.

32
Adolescent Suicide What to dowhen a student is
involuntary.
  • Find out if the student is willing to be
    hospitalized. Encourage the student that if
    they are at danger to themselves than the safest
    place to be is a hospital setting.
  • Always have the student in sight. Even in the
    bathroom!
  • If they are unwilling to be voluntarily
    hospitalized than you should contact your local
    mental health center and talk with crisis line.
    You will either be asked to bring the student to
    the Emergency Room or to fill out some paperwork
    in order to do a Involuntary Emergency Admission
    (IEA). Once the IEA is filled out the police can
    be called to assist you in transporting the
    student to the emergency room.
  • This is a long and difficult process so be
    prepared for spending a great deal of time.

33
Adolescent Suicide What happens in an emergency
room in an IEA.
  • The student will be medically screened by ER
    doctor. Once student is medically clear than the
    local emergency service mental health worker will
    be called.
  • The emergency service mental health worker will
    assess the student to see if they are suicidal or
    not.
  • If the student is found to be suicidal (as
    decided by the mental health worker) they will
    IEA the student.
  • If the student is found not to be suicidal (as
    decided by the mental health worker) you will
    have the student back with you.
  • If student is IEAd they will attempt to find bed
    space some where in the state. This will take a
    long period of time.

34
Adolescent Suicide What happens in an emergency
room
  • If the student is found suicidal they will be
    either admitted to the hospital or will be
    transferred to a local psychiatric hospital, if
    there is a bed.
  • While this process is going on- average time
    about five to eight hours.

35
References
  • Depression in Children and Adolescents
    Athealth.com. Kellermann AL, Rivara FP, Somes G,
    et al. Suicide in the Home in Relation to Gun
    Ownership. New England Journal of Medicine.
    1992327467-472.
  • Lyubomirsky, S. (2006). The how of happiness .
    New York Penguin Press.
  • NAMI website www.nami.org/
  • NAMI NH website www.naminh.org/
  • NIMH Website www.nimh.nih.gov/
  • Center for Disease control www.cdc.gov/nchs/
  • Report from the Surgeon Generalhttp//www.surgeon
    general.gov/library/mentalhealth/chapter3/sec5.htm
    l
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